Unexplained syncope (UPS) is a common clinical disease.It may occur at all ages.But the pothogenisis of UPS is still unclear.There are many researches at home and abroad reporting that the cardiovascular system has endogenous circadian rhythm.And the circadian variations of autonomic nervous system,ambulatory blood pressure,and heart rate variability may contribute to the observed circadian rhythm of cardiovascular.Sudden cardiac and cerebral events are most common in the morning.The time rhythm of UPS may have potential implications for management.

Objective To investigate the relationship between the serum concentration of neuron-specific enolase (NSE) and the brain damage severity and the prognosis of acute head injuried patients. Methods Early serum levels of NSE were measured in 70 patients with acute head injury by radioimmunoassay. The concentration of NSE was analysed by combining with GCS and GOS systems. Results NSE levels in serum of patients with major(a), minor(b) head injuries and control individuals(c) were (25 78 ? 10 80)ng/ml, (19 58 ? 8 91)ng/ml and (9 51 ? 2 79)ng/ml respectively, differences of which were significant (P a-b

Ninety normal subjects were determined by the respofnse of the skin to sunlight, and were classified as sun--reactive skin types of Ⅲ, Ⅳ, Ⅴ,most of them were type Ⅳ (80. 11 % ),to the next were types Ⅴ and Ⅲ. The minimal erythema dose (MED) to UVB and UVA,and the immediate pigment darkening reaction(IPD) to UVA radiation were measured for each type. Bivariate correlation analysis showed a positive correlation between the MED UVB and MED- UVA (r= 0. 47d, P＜O. 001 ). The mean IPDUVA was significantly lower than the mean MED--UVA. Both mean MED--UVB and MED--UVA were significantly higher among the subjects in this study in comparison with the English people with skin types Ⅱ and Ⅲ. The validity of sun--reactive skin type in the study on photosensitive skin diseases and phototherapy is discussed.

Osteonecrosis is the most common disorder in femoral head and scaphoid. However, avascular necrosis (AVN) in metacarpal head is a rare disease. In the present study, a 14-year-old male patient complained of right-hand pain with a limited range of motion for one month. Physical examination showed that the active flexion was 70° and the extension was limited to 30° of the metacarpophalangeal (MCP) joints. The grip strength decreased to 60% of the contralateral hand. X-rays demonstrated flattening and sclerotic changes in the long finger and ring finger of metacarpal head. CT scanning indicated cystic, osteochondral defects and sclerotic changes in metacarpal head. Imaging examination further confirmed the diagnosis of AVN in the long metacarpal finger and ring finger. After conservative treatments including splint immobilization, non-steroidal anti-inflammatory drugs (NSAIDs) and physiotherapy, the local pain symptoms of the MCP joint gradually disappeared. The range of motion of MCP joint returned to normal with the grip strength score as 105% of the contralateral hand. MRI confirmed excellent remodeling and regeneration in the metacarpal head at two years later. The clinical characteristics, diagnosis and treatments of AVN of metacarpal head were reviewed. Although radiograph examination is commonly used, early-stage osteonecrosis of the metacarpal head should be confirmed by MRI. Given the rarity of this disorder, there is no consensus on the treatments. Metacarpal necrosis is the more common disorder in adolescent patients with a history of trauma. Considering the potential of bone remodeling, juveniles with metacarpal head necrosis could recover by conservative treatments.

At present,transplantation has been the predominant way to solve most of the end-stage diseases,ensued by the use of immunosuppressive drugs.Since the immunosuppressive drugs have narrow therapeutic index,the blood drug concentration is needed to mornior.Pharmacogenetics is one subject which focuses on the interaction between gene and the metabolism of the drug,providing great help for designing the regime of achieving the target drug concentration.Meanwhile,it facilitates the realization of individual therapy.This review thus focuses on the latest advancement on the pharmacogenetics of those immunosupprressants,hoping to provide help for the treatment.

Objective To investigate the correspond of microsatellite instability (MSI) on the prognosis and the effect of chemotherapy for colorectal cancer.Methods The publications about the MSI of colorectal cancer from January 2011 to October 2012 were searched.The Web of Knowledge and MEDLINE (PubMed) databases were used for searching English articles.The CNKI and WanFang databases were used for searching Chinese articles.Statistical analysis and graphics were performed with Comprehensive Meta Analysis V2 software.Results Thirty papers were included in this study.For the prognostic Meta-analysis,MSI-H was a protective factor for the overall survival of patients (OR =0.634,0.558-0.720; P ＜ 0.001).Simultaneously,MSI-H was a protective factor for the disease-free survival of patients (OR =0.571,0.479-0.681; P ＜ 0.001).After using of 5-Fu,the survival rate of MSS/MSI-L patients could be significantly elevated (OR =0.515,0.433-0.611; P ＜ 0.001).However,the survival rate of MSI-H patients did not increase significantly (0.631,0.302-1.318; P =0.220).Conclusions Both the overall survival and disease-free survival of MSI-H patients were significantly better than that of MSS/MSI-L patients.For MSS/MSI-L patients,the chemotherapy effect was remarkable.However,for MSI-H patients,there was no statistics difference between chemotherapy and no-chemotherapy group.

Objective To investigate the phenotypes and expression of activated T-cell membrane molecules on lymphocytes in the peripheral blood(PB) of children with aplastic anemia (AA) and find out its clinical significance.Methods The lymphocytes from PB of the 115 AA patients were analyzed by flow cytometry and compared with normal group.Results The expression of CD8+ increased and the expression of CD4+ decreased. The ratio of CD4/CD8 cells decreased ,and was more significant in the patients with serious AA(SAA). The expression of HLA-DR and ??T-cell also increased, and was more significant in SAA patients. The expression of CD3+ was not significantly changed.Conclusions There is significant immune abnormal in AA patients and more important in SAA patients. The immunosuppressant is useful in clinical treatment.

Objective To observe the effect of astragaloside IV (A) and SB203580 antagonize cadmium (Cd) toxicity on expression of associated protein and blood-testis barrier(BTB) in rats and to study the protective mechanism of A on it.Methods Totally 21 SD male rats were randomly divided into 7 groups, 3 rats per group:Cd [ intraperitoneally injected with 0.1%CdCl2,1mg/(kg?d)],Cd+A [at the above dose of CdCl2,at the same time with A,10mg/(kg?d)], and Cd +SB203580 [at the above dose of CdCl2,at the same time with SB203580,100μg/(kg?d)], each of the above groups was further divided into continuous five and ten days treatment groups .The control group was intraperitoneally injected with equal dosage of normal saline .The testes were studied by light , electron microscopy , immunohistochemistry and Western blotting .Results In the control group ,irregular and lightly stained nuclei of Sertoli cell ( Sc) in seminiferous tubules were observed by HE staining .A continuous electron density line of tight junction ( TJ) and normal ultrastructure of BTB were observed .After Cd treatment ,the vesicular formation in the Sc was observed .The ultrastructural damage of Sc and TJ was observed .Compared with the corresponding time point of Cd group ,these were weakened in morphology of testis and ultrastructure of TJ after Cd +A or Cd +SB203580 treatment .The positive products of zonula occludens-1 ( ZO-1 ) and claudin-11 were localized mainly in the base of the seminiferous tubule .After Cd treatment , the average absorbance (AA) of ZO-1 and Claudin-11 was decreased significantly compared with that of the control group (P<0.05).After Cd +A or Cd +SB203580 treatment,AA of ZO-1 and Claudin-11 were increased significantly compared with that of the Cd group(P<0.05),though lower than that of the control group .The result of Western blotting showed that phosphorylation-p38MAPK in Cd group was increased significantly compared with that of the control group (P<0.05).After Cd +A or Cd+SB203580 treatment, it was decreased significantly compared with that of the Cd group (P<0.05).Conclusion Cd decreases ZO-1 and Claudin-11 expression and damages ultrastructure of TJ in BTB , asⅣhas protective effect on it , and is related to inhibiting activation of p 38 MAPK pathway .

Objective To investigate the destructive effect of cadmium (Cd)and the protective effect of astragaloside ( Asd) on TM3 cells.Methods The best protective concentration of Asd on TM 3 cells after Cd treatment was selected by MTT cell viability experiment .The apoptosis rate of TM3 cells was measured by flow cytometry .The expression of connexin 43(Cx43) was detected by immunohistochemistry .The morphological changes of TM3 cells were observed by electron mi-croscopy .Results The viability of TM3 cells in both control and Asd-treated group was not significantly different after 24 h or 48 h,but it was significantly decreased in Cd group .However , the viability of TM3 cells in Cd +As group was higher than that in Cd group .Flow cytometry showed that there was no significant difference in the apoptosis rate of TM 3 cells be-tween the control and Asd-treated group after 24 h,but it was obviously increased with the Cd concentration .The apoptosis rate of Cd+Asd group was lower than that in Cd group (P<0.01).Immunohistochemistry demonstrated that the average optical density (AOD) of the positive product of Cx43 in Cd-treated TM3 cells was obviously decreased (P<0.01), but the average gray value (AGV) was significantly increased when compared with the control group (P<0.01).The ultra-structural changes in TM3 cells were obvious after Cd treatment ,but those in Cd+Asd group were improved when compared with Cd group.Conclusion Cd reduces the expression of Cx 43 and damages the morphology of TM 3 cells.Asd has protec-tive effect on Cd-induced TM3 cell injury.

Aim To study the changes of the biological behavior of dermal fibroblasts in Ⅲ skin burns wound in rats using chitosan.Methods Wistar rats were randomly divided into 5 groups as follows:1% chitosan(W/V)group,2% chitosan(W/V)group,4% chitosan(W/V)group,bFGF(basic fibroblast growth factor) group and the control group.Rats were made for Ⅲ skin burns.The wound healing time was recorded,and the wound healing rate was calculated.Then the cell cycle and apoptotic dermal fibroblasts were determined and the amount of Hydroxyproline(HOP) in the skin tissue was analyzed.Results The wound healing rate of 4% chitosan(W/V) group was higher and the wound healing time of 4% chitosan(W/V) group was shorter than that of the control group.On the 7th,14th day post-injury,the content of protein of 4% chitosan(W/V) group was higher than that of the control group.The content of HOP of 2% and 4% chitosan(W/V) group was highest on the 7th day post-injury. Compared with that in control group,the percentage of cells of S stage in 4% chitosan(W/V) group was aboundant,and was reduced in apoptotic dermal fibroblasts.Conclusion The changes of cellular biological behaviors might be one of the mechanisms of that Chitosan could promote the wound healing of Ⅲ skin burns in rats significantly.